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Consensus Guidelines for Advice to Neurology Patients Who May Experience COVID-19 Infection

Neurology patients who are on immunosuppressive / immunomodulatory medication
Neurology patients who are not on immunosuppressive / immunomodulatory medication

Neurology patients often telephone their Consultant Neurologist for advice on a variety of issues. They sometimes do this after first asking their GP, and being told to contact their neurologist, or sometimes neurologists are their first contact. All neurologist will expect to receive calls from patients with a neurological diagnosis, and who is worried about symptoms of COVID-19 infection.

For the purpose of these guidelines, patients are divided into two categories – those who are on immunosuppressive medication, and those who are not.

Neurology patients who are on immunosuppressive / immunomodulatory medication

The majority of these patients have multiple sclerosis (MS), and are on disease modifying therapy treatments (DMTs).

A small number may have other disorders (e.g. vasculitis neuropathy, autoimmune encephalitis, myasthenia gravis), and may be on other immunosuppressive medications, such as prednisolone or azathioprine.

The MS DMTs which may predispose patients to higher risks of acquiring Covid-19 infection are:

fingolimod and ocrelizumab (moderate)
alemtuzumab and cladribine (significantly higher in the 3 to 6 months after each dose)

For those with symptoms which may suggest COVID-19 infection, regardless if they are mild or severe, patients should be advised according to the HSE Guidelines.

Currently these advise that patients should contact their GP for appropriate COVID-19 testing. If there is a significant concern about the medical condition of the patient, the patient should advised to self-isolate and to contact the HSE Live COVID Contact Centre, or contact the GP directly.

Patients should not be advised to present directly to the Emergency Room unless in extremis.

Neurology patients who are not on immunosuppressive / immunomodulatory medication

This refers to the majority of Neurology patients, including those with MS who are on DMTs other than those noted above.

Mild symptoms. The patient should be advised to self-isolate and to call their GP for advice regarding further management, including arranging testing through the community assessment hub, as above.
Severe symptoms. If the patient has significant persistent symptoms, and sounds medically unwell (as best as can be assessed by phone), they should be advised to self-isolate and arrange an urgent COVID testing according to the algorithm above.
If there is a perceived significant medical concern, the Neurologist should call the HSE COVID line directly and arrange urgent transfer to the Community Assessment hub

Funding has been made available for 32 community hubs the purpose of which is to divert the assessment of those with suspected or confirmed COVID-19 from General Practice / Primary Care. These hubs are likely to be existing Primary Care Centres which will be repurposed as COVID Community Assessment Hubs. The 35 locations are currently being determined.

Purpose of Community Assessment Hubs

The community assessment hub will provide for the examination of patients and will determine the next stage in their pathway, which can be:

The patient goes home.
The patient requires further monitoring -this can be referred to NEOC for follow up
The patient requires admission to an intermediate care centre
The patient requires admission to an acute hospital

Assessments will be completed by healthcare staff in the COVID Community Assessment Hubs either in person or via weblink. Assessment forms and decision-making tools for onward referrals will be available and are currently under construction.

An outreach service will be required to assess/ support people who cannot travel to the community assessment hub.